Department of Internal Medicine, Hospital Kuala Lipis, Kuala Lipis, Pahang, Malaysia
Department of Haematology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia.
BMJ Case Rep. 2022 Mar 9;15(3):e246922. doi: 10.1136/bcr-2021-246922.
Acquired haemophilia A (AHA) is a rare bleeding disorder with high morbidity and mortality, but it is eminently treatable if diagnosis and treatment are prompt. We report a case of AHA in Southeast Asia following the administration of the Pfizer-BioNTech COVID-19 vaccine. A man in his 80s developed multiple bruises 2 weeks after his first dose of the COVID-19 vaccine. Diagnosis was delayed due to his cognitive impairment and low clinical suspicion. This led to a representation with worsening ecchymosis, a left thigh haematoma and symptomatic anaemia. Laboratory testing was notable for an isolated prolongation of the activated partial thromboplastin time, which remained uncorrected in the mixing test. Further testing confirmed the presence of factor VIII (FVIII) inhibitors and low FVIII titres of 6.7%. He responded to treatment with intravenous methylprednisolone and recombinant activated FVII. Screening for autoimmune diseases and malignancies was negative.
获得性血友病 A（AHA）是一种罕见的出血性疾病，具有较高的发病率和死亡率，但如果诊断和治疗及时，是可以治疗的。我们报告了一例在东南亚接种辉瑞-生物技术公司的 COVID-19 疫苗后发生的 AHA 病例。一名 80 多岁的男性在接种第一剂 COVID-19 疫苗后 2 周出现多处瘀斑。由于认知障碍和低临床怀疑，诊断被延误。这导致瘀斑恶化、左大腿血肿和症状性贫血。实验室检查显示活化部分凝血活酶时间延长，混合试验中未纠正。进一步的检查证实存在因子 VIII（FVIII）抑制剂和低 FVIII 效价 6.7%。他对静脉注射甲基强的松龙和重组活化 FVII 的治疗有反应。自身免疫性疾病和恶性肿瘤的筛查均为阴性。
